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To date, psychosocial outcomes after facial transplantation are promising although long-term consequences, outcome of blind patients and the impact on family members are less well investigated. The aim of this study was to examine the long-term psychosocial of a blind patient and his partner 2 and 3 years after facial transplantation.

Methods

Depressive and anxiety symptoms, hopelessness, coping, resilience, illness cognitions, marital support, dyadic adjustment, family functioning and quality of life of the patient and the partner were assessed before and 2 and 3 years after transplantation. Reliable change index (RCI) was further calculated to evaluate the magnitude of change.

Results

Most psychological, marital and family scores of both the patient and the partner remained within a normative and healthy range at follow-up. Resilience (RCI: 2.5 & 3.4 respectively), affective responsiveness (RCI: −4.1 & −3.2 respectively), physical quality of life (RCI: 8.7 & 7.2 respectively) and helplessness (RCI: −2.2 & −2.9 respectively) of the patient improved at 2 and 3 years follow-up. Further, dyadic cohesion (RCI: 2.4) of the patient improved at 2 years whereas marital depth (RCI: −2.0) of the partner decreased at 3 years.

Conclusions

The results of this study point to positive long-term psychosocial outcomes of a blind patient and his partner after facial transplantation. Further, they may underscore the importance of patient selection, social support and involvement of family members in treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

For decades antimonials were the drugs of choice for the treatment of visceral leishmaniasis (VL), but the recent emergence of resistance has made them redundant as first-line therapy in the endemic VL region in the Indian subcontinent. The application of other drugs has been limited due to adverse effects, perceived high cost, need for parenteral administration and increasing rate of treatment failures. Liposomal amphotericin B (AmB) and miltefosine (MIL) have been positioned as the effective first-line treatments; however, the number of monotherapy MIL-failures has increased after a decade of use. Since no validated molecular resistance markers are yet available, monitoring and surveillance of changes in drug sensitivity and resistance still depends on standard phenotypic in vitro promastigote or amastigote susceptibility assays. Clinical isolates displaying defined MIL- or AmB-resistance are still fairly scarce and fundamental and applied research on resistance mechanisms and dynamics remains largely dependent on laboratory-generated drug resistant strains. This review addresses the various challenges associated with drug susceptibility and -resistance monitoring in VL, with particular emphasis on the choice of strains, susceptibility model selection and standardization of procedures with specific read-out parameters and well-defined threshold criteria. The latter are essential to support surveillance systems and safeguard the limited number of currently available antileishmanial drugs.

The distribution of phlebotomine sand flies is widely reported to be changing in Europe. This can be attributed to either the discovery of sand flies in areas where they were previously overlooked (generally following an outbreak of leishmaniasis or other sand fly-related disease) or to true expansion of their range as a result of climatic or environmental changes. Routine surveillance for phlebotomines in Europe is localized, and often one of the challenges for entomologists working in non-leishmaniasis endemic countries is the lack of knowledge on how to conduct, plan and execute sampling for phlebotomines, or how to adapt on-going sampling strategies for other haematophagous diptera. This review brings together published and unpublished expert knowledge on sampling strategies for European phlebotomines of public health concern in order to provide practical advice on: how to conduct surveys; the collection and interpretation of field data; suitable techniques for the preservation of specimens obtained by different sampling methods; molecular techniques used for species identification; and the pathogens associated with sand flies and their detection methods.

Among the invasive mosquitoes registered all over the world, Aedes species are particularly frequent and important. As several of them are potential vectors of disease, they present significant health concerns for 21st century Europe. Five species have established in mainland Europe, with two (Aedes albopictus and Aedes japonicus) becoming widespread and two (Ae. albopictus and Aedes aegypti) implicated in disease transmission to humans in Europe. The routes of importation and spread are often enigmatic, the ability to adapt to local environments and climates are rapid, and the biting nuisance and vector potential are both an ecomonic and public health concern. Europeans are used to cases of dengue and chikungunya in travellers returning from the tropics, but the threat to health and tourism in mainland Europe is substantive. Coupled to that are the emerging issues in the European overseas territorities and this paper is the first to consider the impacts in the remoter outposts of Europe. If entomologists and public health authorities are to address the spread of these mosquitoes and mitigate their health risks they must first be prepared to share information to better understand their biology and ecology, and share data on their distribution and control successes. This paper focusses in greater detail on the entomological and ecological aspects of these mosquitoes to assist with the risk assessment process, bringing together a large amount of information gathered through the ECDC VBORNET project.

To advance our restricted knowledge on mosquito biodiversity and distribution in
Belgium, a national inventory started in 2007 (MODIRISK) based on a random
selection of 936 collection points in three main environmental types: urban,
rural and natural areas. Additionally, 64 sites were selected because of the
risk of importing a vector or pathogen in these sites. Each site was sampled
once between May and October 2007 and once in 2008 using Mosquito Magnet Liberty
Plus traps. Diversity in pre-defined habitat types was calculated using three
indices. The association between species and environmental types was assessed
using a correspondence analysis. Twenty-three mosquito species belonging to
traditionally recognized genera were found, including 21 indigenous and two
exotic species. Highest species diversity (Simpson 0.765) and species richness
(20 species) was observed in natural areas, although urban sites scored also
well (Simpson 0.476, 16 species). Four clusters could be distinguished based on
the correspondence analysis. The first one is related to human modified
landscapes (such as urban, rural and industrial sites). A second is composed of
species not associated with a specific habitat type, including the now widely
distributed Anopheles plumbeus. A third group includes species
commonly found in restored natural or bird migration areas, and a fourth cluster
is composed of forest species. Outcomes of this study demonstrate the
effectiveness of the designed sampling scheme and support the choice of the trap
type. Obtained results of this first country-wide inventory of the Culicidae in
Belgium may serve as a basis for risk assessment of emerging mosquito-borne
diseases.

Background and objective: We investigated whether a high bolus dose of cisatracurium (8× ED95) given at induction can provide muscle relaxation for the major part of a cardiac procedure with hypothermic cardiopulmonary bypass, avoid important postoperative residual curarization and cause no waste of product.

Methods: Twenty patients were randomly assigned either to Group 1 (n = 10) or Group 2 (n = 10). Those in Group 1 were given cisatracurium in a high bolus dose (0.4 mg kg−1). Those in Group 2 received cisatracurium 0.1mg kg−1 at induction followed after 30 min by a continuous infusion of cisatracurium. As an escape medication in case of patient movement, a bolus dose of cisatracurium 0.03 mg kg−1 was given.

Results: In Group 1 (large cisatracurium bolus dose), the clinical duration of effect (until T1/T0 = 25%) was 110 min. Six of 10 patients in Group 1 required additional boluses of cisatracurium intraoperatively. Four of these six had received an additional bolus near the end of surgery and had a train-of-four (TOF) ratio = 0 at the end. The other four patients in Group 1 had a final TOF ratio >0.9. In Group 2 (continuous cisatracurium infusion), only two patients had a TOF ratio >0.9 at the end of surgery, no patient moved and none received additional boluses. The total amount of cisatracurium used in the bolus and infusion Groups was 34.5 ± 7.8 and 21.3 ± 5.7 mg, respectively (P = 0.0004).

Conclusions: For continued neuromuscular block during hypothermic cardiac surgery, a high bolus dose of cisatracurium appears to be safe, although it is not an alternative to a continuous infusion, as its neuromuscular blockade does not cover the intraoperative period and a high incidence of movements occurs. In the patients who received a high bolus dose of cisatracurium, postoperative residual curarization appeared after additional boluses had been given. The consumption of cisatracurium by high bolus was significantly greater than with continuous infusion.

Background and objective: When continuous infusions of neuromuscular blocking drugs are administered during lengthy interventions and no routine antagonism of their effects is applied, there is a dramatic incidence of residual curarization. We have examined whether the use of neuromuscular transmission monitoring results in differences in the incidence of postoperative residual curarization, the use of antagonist agents, and the endotracheal extubation rate and outcome after continuous infusion of rocuronium in patients undergoing off-pump coronary artery bypass surgery.

Methods: Twenty patients were assigned to group 1 (n = 10, non-blinded neuromuscular transmission monitoring) or group 2 (n = 10, blinded neuromuscular transmission monitoring). In group 1, patients were given rocuronium at an infusion rate of 6 μg kg−1 min−1. The rate was manually adjusted in order to maintain T1/T0 at 10%. In group 2, a rocuronium infusion was started 30 min after induction of anaesthesia, at a rate of 6 μg kg−1 min−1; this rate was left unchanged during surgery. The rocuronium infusion was discontinued on completion of all vascular anastomoses; propofol was stopped at the beginning of closure of the subcutis and pirinitramide (piritramide) 15 mg was administered intravenously. Remifentanil was discontinued at the beginning of skin closure and neostigmine (50 μg kg−1) administered at the end of surgery when the train-of-four ratio was <0.9 in group 1, and routinely in group 2. A 20 min test period for spontaneous ventilation was allowed once surgery had been accomplished. When the train-of-four ratio was ≥0.9 (group 1), patients were extubated if also breathing spontaneously, fully awake and able to follow commands. When they met the clinical criteria for normal neuromuscular function after induced blockade, patients in group 2 were extubated when fully awake and able to follow commands.

Results: In group 1, the rate of rocuronium infusion required to keep T1/T0 at 10% was 5 ± 1.9 μg kg−1 min−1; this was not significantly different from the fixed rate in group 2 (P = 0.15). One patient in group 2 was excluded. Eight out of 10 and eight out of nine patients in groups 1 and 2, respectively, reached the extubation criteria. Three out of eight, and five out of eight, patients from groups 1 and 2, respectively, were extubated in the operating room. At that time of endotracheal extubation, all three patients from group 1, but only four of the five patients from group 2 had a train-of-four ratio ≥0.9. In group 2, one patient was reintubated in the intensive care unit. The incidence of pharmacological reversal was high in group 1.

Conclusions: Although we found no additional benefit of using neuromuscular transmission monitoring, it seems an absolute necessity for safety reasons. Pharmacological antagonism was mandatory. However, in our opinion, it is not wise routinely to perform immediate postoperative extubation in off-pump coronary artery bypass surgery.

Low level radioactive liquid discharges have been carried out in the Loire
river since 1963. Since then, the number of power plants located on the Loire
river and its tributaries has been steadily increasing to reach, in the year
2000, 14 reactors operating on 5 different sites. The question arose to evaluate
to what extent the addition of several nuclear power plants on the same river
system could increase the concentrations in radionuclides in the environment
and affect the dose to the public. To address this issue, EDF initiated in 1998
the “Loire river and estuary radioecology” program with the focus on assessing
possible accumulation of radionuclide in river bottom sediments or on river shores.
The following radionuclides were considered because of their importance in power
plant liquid discharges: tritium, 14C, 58Co, 60Co,
$^{110{\rm m}}$
Ag,
134Cs, 137Cs, 54Mn, 124Sb, and 131I. Radionuclide concentrations
in the dissolved, particulate and sedimentary forms were evaluated using the CRESCENDO model.
The development and validation of this model required a multi-step process. The first step was
to design a 350-km long 1D hydraulic and water transport based on currently available
tools and data. Next, daily tritium concentrations measured in Angers, at the downstream
limit of the river, were compared with computed values. The following step was to
calibrate the sediment transport model. Areas where fine particles settled (dams and river
shores) were monitored to improve our understanding of sediment dynamics. Then equations
representing radionuclide exchange between water and particles were derived from
laboratory experiments and included in the model. After each step the computed values
were compared to measure data sets to ensure the model adequately described the
processes involved. In the final step, the CALVADOS model was used to calculate
dose to the public at different locations along the Loire river.

A raster or grid-based Geographic Information System with data on tsetse, trypanosomiasis, animal production, agriculture and land use has recently been developed in Togo. The area-wide sampling of tsetse fly, aided by satellite imagery, is the subject of two separate papers. This paper on a first paper, published in this journal, describing the generation of digital tsetse distribution and abundance maps and how these accord with the local climatic and agro-ecological setting. Such maps when combined with data on the disease, the hosts and their owners, should contribute the knowledge of the spatial epidemiology of trypanosomiasis and assist planning of integrated control operations. Here we address the problem of generating tsetse distribution and abundance maps from remotely sensed data, using a restricted amount of field data. Different discriminant models have been applied using contemporary tsetse data and remotely sensed, low resolution data acquired from the National Oceanographic and Atmospheric Administration (NOAA) and Meteosat platforms. The results confirm the potential of satellite data application and multivariate for the prediction of the tsetse distribution and abundance. This opens up new avenues because satellite predictions and field data may be combined to strengthen and/or substitute one another. The analysis shows how the strategic incorporation of satellite imagery may minimize field of data. Field surveys may be modified and conducted in two stages, first concentrating on the expected fly distribution limits and thereafter on fly abundance. The study also shows that when applying satellite data, care should be taken in selecting the optimal number of predictor because this number varies with the amount of training data for predicting abundance and on the homogeneity of the distribution limits for predicting fly presence. Finally, it is suggested that in addition to the use of contemporary training data and predictor variables, training predicted data sets should refer to the same eco-geographic zone.

Information on the spatial pattern of African animal trypanosomosis forms a prerequisite for rational disease management,
but few data exist for any country in the continent. The present study describes a raster or grid-based Geographic
Information System for Togo, a country representative of subhumid West Africa, with data layers on tsetse, trypanosomosis,
animal production, agriculture and land use. The paper shows how trypanosomosis prevalence and packed cell
volume (PCV) map displays may be predicted from correlations between representative field data and environmental and
satellite data acquired from the National Oceanographic and Atmospheric Administration (NOAA) and Meteosat platforms.
Discriminant analytical methods were used to assess the relationship between the amount of field data used and
the accuracy of the predictions obtained. The accuracy of satellite derived predictions decreases from tsetse abundance
to trypanosomosis prevalence to PCV value. The predictions improve when eco-climatic and epidemiological predictors
are combined. In Togo, and probably elsewhere, the patterns of trypanosomosis prevalence and PCV are much influenced
by animal husbandry and other anthropogenic factors. Additional predictor variables, incorporating these influences might
therefore further improve the models.

A raster or grid-based Geographic Information System with data on tsetse, trypanosomosis, animal production, agriculture and land use has recently been developed in Togo. This paper describes the generation of area-wide digital tsetse distribution and abundance maps and how these accord with the local climatic and agro-ecological setting. Results include: (i) a spatial demarcation of ecologically distinct areas, producing a seasonal cluster map based on seasonal weather data and temporal series of satellite derived National Oceanic and Atmospheric Administration (NOAA) AVHRR and METEOSAT variables: (ii) tsetse distribution maps of Glossina tachinoides Westwood, G. palpalis palpalis (Robineau-Desvoidy), G. morsitans submorsitansNewstead, G. longipalpis Wiedemann, G. medicorum Austen and G. fusca fusca (Walker); and (iii) tsetse abundance or ‘risk’ maps, corrected for within database seasonal fluctuations, for G. tachinoides and G. p. palpalis. It is concluded that grid-based sampling is the ideal method for rapid assessment of the current vector and disease situation within any country or region, and that remote sensing has an important role to play in planning such a sampling system.

An unusual Ni distribution with two completely separated buried and surface suicide layers has been observed after Ni ion implantation in Si(111) kept at a temperature of 300° C, with a dose of 1.1 × 1017/cm2 and at a fixed energy of 90 keV. RBS/channeling, AES and cross-sectional TEM have been used to study this phenomenon as a function of the substrate temperature and Co co4mplantation. A model is presented, based on the diffusion of the transition metal, the defect annealing during the implantation, and the gettering power of the surface and the end of range defects.

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